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Surgery 1 (SAB) > Lecture 6: Suture Materials & Patterns > Flashcards

Lecture 6: Suture Materials & Patterns Flashcards

1
Q

What are suture’s important role in wound repair

A
  • Provides hemostasis
  • Supports healing tissue by apposing & supporting tissue layers
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2
Q

What determines the type of suture needed

A
  • Type of tissue
  • Anticipated duration of healing
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3
Q

What can cause delaying healing of wounds

A
  • Infection
  • Obesity
  • Malnutrition
  • Neoplasia
  • Drugs
  • Collagen disorders
  • Hypoproteinemia
  • Radiation therapy
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4
Q

What is the function of suture

A

Maintain apposition of tissue until wound’s tissue strength returns

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5
Q

Describe the ideal suture

A
  • Easy to handle
  • Reacts minimally in tissue
  • Inhibits bacterial growth
  • Holds securely when knotted
  • Resists shrinking in tissue
  • Absorbs w/ minimal reaction after the tissue has healed
  • Noncapillary
  • Nonallergenic
  • Noncarcinogenic
  • Nonferromagnetic
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6
Q

T/F: The ideal suture material does exist

A

False: It doesn’t exist

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7
Q

What is the commonly used standard for suture size

A

United States Pharmacopeia (USP)

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8
Q

Describe USP

A
  • Denotes dimensions from fine to coarse
  • According to a numeric scale
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9
Q

What is the smallest suture size

A

12-0

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10
Q

What is the largest suture size

A

7

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11
Q

How is “0” read

A

Ought

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12
Q

What should the smallest diameter suture (that will adequately secure wounded) be used for

A
  • Minimaize trauma as the suture is passed through the tissue
  • Reduce the amount of foreign material left in the wound
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13
Q

Is there an advantage to using a suture that is stronger than the tissue being sutured

A

No

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14
Q

What determines the flexibility of a suture

A

Its torsional stiffness & diameter

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15
Q

What influences sutures handling & use

A

Its torsional stiffnes & diameter

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16
Q

What are flexible sutures used for

A

Ligating vessels or performing continuous suture patterns

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17
Q

What cannot be used to ligate small bleeders

A

Less flexible sutures like wire

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18
Q

What is considered stiff compared to silk suture

A
  • Nylon
  • Surgical gut
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19
Q

What type of stiffness does braided polyester have

A

Intermediate

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20
Q

What do the surface characteristics of a suture influence

A
  • The ease w/ which it is pulled through tissue (the amount of friction of “drag”)
  • The amount of trauma caused
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21
Q

(Rough/smooth) sutures causes more injury

A

Rough

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22
Q

(Rough/Smooth) are particularly important in the delicate tissues like the eye

A

Smooth

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23
Q

What are the cons of sutures w/ smooth surfaces

A
  • Require greater tension to ensure good apposition of tissues
  • have less knot security
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24
Q

Which material has more drag than monofilament sutures

A

Braided materials

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25
Q

Why are braided materials often coated

A
  • Reduce capillarity
  • Provides a smooth surface
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26
Q

What are braided materials usually coated w/

A
  • Teflon
  • Silicone
  • Wax
  • Paraffin wax
  • Calcium stearate
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27
Q

What is capillarity

A
  • The process by which fluid & bacteria are carried into the interstices of multifilament fibers
  • Neutrophils & macrophages are too large to enter interstices of the fiber (infection can persist particularly in nonabsorbable sutures)
  • Braided materials have degrees of capillarity
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28
Q

What suture is considered noncapillary

A

Monofilament

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29
Q

What reduces the capillarity of some sutures

A

Coating

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30
Q

Where should capillary suture materials not be used

A

In contaminated or infected sites

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31
Q

What is knot tensile strength

A
  • Measured by the force in pounds that the suture strand can withstand before it breaks when knotted
  • Sutures should be as strong as the norm tissue through which they are being placed
  • Tensile strength should not greatly exceed the tensile strength of the tissue
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32
Q

Define relative knot security

A

The holding capacity of a suture expressed as a % of its tensile strength

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33
Q

Define knot holding capacity

A

The strenth required to untie or break a defined knot by loading the part of the suture that forms the loop

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34
Q

Define tensile strength

A

The strength required to break an untied fiber with a force applied in the direction of its length

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35
Q

Describe monofilament suture

A
  • A single strand of material
  • Less tissue drag than multi
  • Do not have interstices that can harbor bacteria or fluid
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36
Q

Why should care be used in handling monofilament suture

A

B/c nicking or damaging the material w/ forceps or needle holders may weaken the suture & predispose it to breakage

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37
Q

Describe multifilament suture

A
  • Consist of several strands of suture that are twisted or braided together
  • More pliable & flexible than mono
  • May be coated to reduce tissue drag & enhance handling characteristics
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38
Q

Compare mono to multi filament

A
  • Mono: nonwicking, more memory, & does not handle as well
  • Multi: wicking, less memory, & good handling
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39
Q

What are the two major mechanisms of absorption that results in the degradation of absorbable sutures

A
  • Sutures of organic origin are gradually digested by tissue enzymes & phagocytized
  • Sutures manufactured from synthetic polymers are principally broken down by hydrolysis
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40
Q

How are nonabsorbable sutures handled by the body

A

Encapsulated or walled off by fibrous tissue

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41
Q

List some absorbable suture materials

A
  • Surgical gut
  • Chromic gut
  • Multifilament
42
Q

Describe absorbable suture materials

A
  • Lose most of their tensile strength w/in 60 days
  • Eventually disappear from the tissue implantation site b/c they have been phagocytized or hydrolyzed
  • The time to loss of strength & for complete absorption varies among suture materials
43
Q

Describe Catgut (surgical gut)

A
  • Most common nonsynthetic absorbable suture material
  • Made from the submucosa of sheep intestine or the serosa of bovine intestine
  • ~90% collagen
  • Broken down by phagocytosis
  • Elicits a notable inflammatory reaction
  • Loses strength rapidly after tissue implantatioon
  • “Tanning” slows absorption
  • Rapidly removed from infected sites or areas where it is exposed to digestive enzymes & is quickly degraded in catabolic px
  • Knots may loosen when wet
44
Q

Describe synthetic absorbable suture

A
  • Broken down by hydrolysis
  • Causes minimal tissue reaction
  • Time to loss of strength & to absorption is fairly constant even in different tissue
  • Infection or exposure to digestive enzymes does not significantly influence the rate of absorption of most synthetic absorbable sutures
  • Polyglycolic acid, polyglactin 910, & poliglecaprone 25 may be rapidly degraded in infected urine
45
Q

What are the types of nonabsorbable suture

A
  • Organic
  • Synthetic
  • Metallic
46
Q

Describe Organic nonabsorbable suture

A
  • Silk is the most common organic nonabsorbable suture
  • Braided multifilament suture made by a special type of silkwork
  • Can be coated or uncoated
  • Excellent handling characteristics
  • Often used in cardiovascular procedures
  • Should be avoided in contaminated sites
47
Q

Describe synthetic nonabsorbable suture

A
  • Braided multifilament threads or monofiliament threads
  • Typically strong & induce minimal tissue reaction
48
Q

Can table ties be implanted in the body, & why not

A
  • Never
  • Release of toxic substances during their degradation & their use may result in abscess or tumore formation
49
Q

Describe metallic sutures

A
  • Stainless stell is most commonly used
  • Monofilament or multifilament twisted wire
  • Surgical steel is strong & inert w/ minimal tissue reaction
  • Knot ends evoke an inflammatory reaction
  • Tendency to cut tissue
  • May fragment & migrate
50
Q

Describe surgical steel

A
  • Is stable in contaminated wounds
  • Standard for judging knot security
  • Standard for judging tissue reaction to suture materials
51
Q

What should be considered for suture selection

A
  • Length of time the suture will be required to help strengthen the wound or tissue
  • Risk of infection
  • Effect of the suture material on wound healing
  • Dimension & strength of the suture required
52
Q

What suture should be used in the skin

A
  • Monofilament to prevent wicking or capillary transport of bacteria to deeper tissue
  • Synthetic monofilament nonabsorbable generally have good relative knot security & are relatively non-capillary
  • Absorbable sutures may be used in the skin but they should be removed b/c absorption requires contact w/ body fluids
53
Q

What suture should be selected for SubQ tissue

A
  • SubQ sutures are used to obliterate dead space & reduce tension on skin edges
  • Multi- or monofilament absorbable suture material is preferred
54
Q

What suture should be selected for abdominal closure

A
  • Can be closed w/ either an interrupted or continuous suture pattern
  • Most surgeons routinely close the rectus fascia w/ a simple contnuous suture pattern
  • Continuous suture pattern = strong nonabsorbable or standard absorbable monofilament suture w/ good knot security should be used
  • one size larger suture than normal is preferred for a continuous suture pattern
  • Knots should be tied carefully & three or four square knows (six or eight throws) should be placed
  • Standard absorbable suture may be preferable to prevent large amounts of foreign material from remaining permanetly in the incision
55
Q

What suture should be selected for muscle

A
  • Muscle has poor holding power & is difficult to suture
  • Can be absorbable or nonabsorbable
  • Sutures placed parallel to the muscle fibers are likely to pull out so consideration should be given to the type of suture pattern chosen
56
Q

What suture should be used for the tendon

A
  • Needs to be strong, nonabsorbable, & minimally reactive
  • A taper or taper-cut needle generally is less traumatic to these tissues
  • Largest suture that will pass w/out trauma through the tendon should be used
57
Q

Which suture should be used for parenchymal organs

A
  • Absorbable monofilament suture
  • Multifilament sutures tend to cut through this type of tissue b/c of the increased drag
58
Q

What suture should be used for hollow viscus organs

A
  • Absorbable monofilament sutures generally are recommended to prevent tissue retention of foreign material once the wound is healed
  • Nonabsorbable may be calculogenic when place in the urinary bladder or gallblader & may be extruded into the lumen when implanted in the intestine
  • Polyglycolic acid (Dexon) suture rapidly dissolves when incubated in sterile urine (6 days) or infected urine (3 days)
59
Q

What suture should be selected for infected or contaminated wounds

A
  • Sutures should be aboided in highly contaminated or infected wounds
  • Multifilament nonabsorbable sutures should not be used in infected tissue
  • Absorbable suture is preferred
  • Surgical gut should be avoided
  • Synthetic monofilament nylon & polypropylene may elicit less infection in contaminated tissue than metallic sutures
60
Q

What sutures should be selected for vessels & vascular anastomoses

A
  • Ligated w/ absorbable suture material
  • Vascular anastomoses are typically performed w/ monofilament nonabsorbable suture material like polypropylene
61
Q

What does selecting a surgical needle depend on

A
  • Type of tissue to be sutured
  • Topography of the wound
  • Characteristics of the needle
62
Q

Why are most surgical needles made from stainless steel

A
  • Strong
  • Corrosion free
  • Does not harbor bacteria
63
Q

Define surgical yield

A

The amount of angular deformation a needle can withstand before becoming permaneltly deformed

64
Q

Define ductility

A

The needle’s resistance to breaking under a specified amount of bending

65
Q

Define sharpness

A

The angle of the point & the taper ratio of the needle

66
Q

What do the sharpest needles have

A

A long thin tapered point w/ smooth cutting edges

67
Q

Describe the basic components of a needle, types of eyed needles, & the shapes/sizes of needle bodies

A
68
Q

What is considered when selecting a curved needle

A
  • The depth & diameter of a wound are impt when select the most appropriate curved needl
  • 1/4 circle needles are primarily used in opthalmic procedures
  • 3/8 & 1/2 circle needles are the most commonly used surgical needles in vet
  • 1/2 or 5/8 circle need is easier to use in confined locations despite needing more pronation & supination of the wrist
69
Q

How can suture patterns be classified

A
  • Interrupeted
  • Continuous
  • Appositional
  • Everting
  • Inverting
  • SubQ
  • Subcuticular/intradermal
70
Q

Define appositional

A

One tissue edge apposed to another

71
Q

Define everting

A

Turn the tissue edges outward awfrom the px & toward the surgeon

72
Q

Define Inverting

A

Turn tissue away from the surgeon or toward the lumen of a hollow viscus organ

73
Q

Elaborate on SubQ sutures

A
  • Eliminate dead space
  • Provide some apposition of skin so that less tension is placed on skin sutures
  • Generally placed in a simple contnuous manner (simple interrupted may be preferable if drainage might be needed)
74
Q

Elaborate on subcuticular sutures

A
  • Suture line is completed w/ a buried knot
  • No sutures are visible externally when complete
  • Absorbable suture materials w/ a cutting needle are preferred for this suture pattern
75
Q

Which is Suctuicular & which is SubQ

A
  • A = Subcuticular
  • B = SubQ
76
Q

List interrupted suture patterns

A
  • Simple interrupted
  • Horizontal mattress
  • Cruciate
  • Vertical mattress
  • Halstead
  • Gambee
77
Q

Describe simple interrupted

A
  • Made by inserting the needle through tissue on one side of an incision or wound, passint it to the opposite side, & then tying it
  • The knot is offset so that it does no rest on top of the incision
  • Ends of the suture are cut
  • For skin sutures the ends are left long enough to allow them to be grasped during removal
  • Sutures are placed approx 2 to 3 mm away from the skin edge
  • Right handed surgeons place sutures from right to left in a horizontal fashion (opp for left handed surgeons)
78
Q

What is the primary advantage of simple interrupted sutures

A

Disruption of a single suture doesn’t cause the entire suture line to fail

79
Q

Do simple continuous or simple interrupted sutures take more time

A

Simple interrupted

80
Q

Which suture pattern results in more foreign material in the wound

A

Simple interrupted

81
Q

Describe horizontal mattress pattern

A
  • Used primarily in areas of tension
  • Placed rapidly
  • Often cause tissue eversion (care should be exercised to appose, rather than evert, tissue margins)
  • Suture should be angled through the tissue so that it passes just below the dermis
  • separated 4 to 5 mm
  • Can be bolstered using rubber stents & buttons
82
Q

Describe the cruciate suture pattern

A
  • Formed when two simple interrupted sutures are placed parallel to each other & then tied across the incision to create and “X”
  • Appositional
  • Can relieve low to moderate tension across an incision
  • Less suture material is used to close a skin incision than w/ simple interrupted
  • Affords the security of an interrupted pattern
83
Q

Which is simple interrupted, horizontal mattress, & cruciate

A
  • A = Simple interrupted
  • B = Horizontal mattress
  • C = Cruciate
84
Q

Describe the vertical mattress pattern

A
  • Stronger than horizontal mattress sutures
  • Preferred when addressing tension in skin closure
  • Less disruption to the blood supply of the wound edges
  • Each bite approx 4 mm from the skin edge
  • Rel time consumin
  • Eversion of the skin margins is less of a prob
  • Can be bolstered using rubber stens & buttons
85
Q

Define stents

A

Placing padded material beneath the suture loops is stenting

86
Q

Describe the halstead suture pattern

A
  • An interrupted mattress pattern that is a modification of a cont lembert pattern
  • Infrequently used in vet med
  • Provides exact skin approx
87
Q

Describe the Gambee suture pattern

A
  • Interrupted pattern used in intestinal surgery to reduce mucosal eversion
  • Also reduces mucosal inversion & may reduce wicking of material from the intestinal lumen to the exterior
88
Q

Which is the vertical mattress, halsted, & Gambee

A
  • D = vertical mattress
  • E = Halsted
  • F = Gambee
89
Q

List the continuous suture patterns

A
  • Simple continuous
  • Running
  • Ford interlocking
  • Lembert
  • Connel
  • Cushing
90
Q

Describe the simple continuous pattern

A
  • Consists of a series of simple interrupted sutures w/ a knot on either end
  • Provides max tissue apposition
  • Relatively air & fluid tight compared w/ a series of simple interrupted sutures
  • Freq used to close the linea alba & SubQ tissue
  • Care should be taken when placing continuous suture lines in areas where tightening of the suture may result in a purse string like effect
91
Q

What is the difference btw/ simple continuous & running suture patterns

A
  • Simple continuous: The needle is then passed through the tissue from one side to the other, perpendicular to the incision; the suture is advanced above the incision line @ a diagonal
  • Running: Created if the suture is advanced above & below the incision line but this is not as secure as less tissue is purchased; not as secure since there is less tissue is purchased
92
Q

Which is the running and which is the simple continuous suture pattern

A
  • Blue = Running
  • Black = Simple continuous
93
Q

Describe the ford interlocking pattern

A
  • Modification of a simple continuous
  • Each passage through the tissue is partly locked
  • Each pass through the tissue is linked to the previous passage as the suture exits the tissue through a created loop of material
  • May be placed quickly
  • May appose tissue better than a simple interrupted pattern
  • Provides greater stability than a simple continuous pattern in the event of a partial break along the line
  • Larger amount of suture material is used
  • Sutures may be more difficult to remove
94
Q

Which suture pattern is this

A

Ford interlocking

95
Q

Describe the Lembert suture pattern

A
  • A variation of a vertical mattress pattern applied in a continuous fashion
  • Is an inverting pattern that is often used to close hollow viscera
96
Q

Describe cushing & connell suture pattern

A
  • Inverting patterns that are used to close hollow organs
  • Watertight seal is created by inversion
97
Q

Whats the differnce btw/ the cushing & connell pattern

A
  • A connell pattern enters the lumen whereas a cushing pattern extends only to the submucosal layer
  • It was prev though that a cushing pattern would be preferable to a connell for cystotomy closure b/c suture material in the lumen might be calculogenic; however the use of rapidly absorbed monofilament sutures negates this concern
98
Q

Which is Lembert, Connell, & Cushing

A
  • D = Lembert
  • E = Connell
  • F = Cushing
99
Q

Describe the parker-kerr oversew

A
  • A two layer closure for inverted closure of a transected,clamped, stump of hollow viscera
  • Begins w/ cushing/connell, followed by an inverting seromuscular pattern
  • Seldomly used b/c it causes excessive tissue inversion
100
Q

What suture configurations are used to approximate severed ends of a tendon or to secure one end of a tendon to bone or muscle

A
  • Kessler locking loop
  • Bennel Mayer
  • Krackrow
  • Three loop pulley
101
Q

Label these suture patterns

A
  • A = Far-near near-far
  • B = Bunnell-Mayer technique
  • C = Three loop pulley
  • D = locking loop

Surgery 1 (SAB) (16 decks)

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